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REQUEST FOR ELECTRICAL INSPECTION �"" �%�
Minnesota State Board of Electricity �',���
1821 Universiry Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800 "�°�
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requesG Enler remarks in Ihis space and on
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Calculaie Inspec�ion Fee - This n�tion Requesi will no� be accepfed wi�hou! ihe correc� fee:
Other Fee N Service Entrance Size Fee # Circuits/Peeders Fee
Mobile Home Park Stall 0 to 200 Amps Z 0 to 100 Amps -
Sfreet Lfp./Trolfic Sig. Above 200_Amps Above 100_Arimps
INSPECTON'S USE ONLY
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on 16e dmes simad
� Investigalive Fee - T' � � �//-{
THIS INSTALLATION MAY BE ORDERED DISCONNECTE IF NOT COMPLETED WYf N 18 MONTHS.
OFFICE USE ONLY This requesl void 18 monihs from v lidmion dme prinled -m lhls box.
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PLEASE PRINT OR TYPE
Request Wy� —� Rough in inspec�ion requiredx ❑ Ves No Inspecfian O�her Than kough-In: eady Now � Will Call
� �Vo� m�s� coll �he Inzpe�ro� when reody) Dok Reody:
I, �ensed contractor ❑ owner hereby request inspe<tion of the above eleckicol work at
Job„�d� j�5rveet, Box, o�oute Np.) � Cly �� _�/ 2p Code
Oaupant
Power
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COVY-SEE
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ON BACK OF VELLOW COPV